Pain & Musculoskeletal
Osteoarthritis, neuropathic pain, muscle relaxants, and the treatment of migraine.
Osteoarthritis: The 'Wear and Tear' Joint, and Why No Drug Fixes It
Osteoarthritis is the commonest joint disease of all — the aching, stiff joints of age and use. It couldn't be more different from rheumatoid arthritis: it's mechanical, not autoimmune, so DMARDs are useless. Understanding that difference explains why treatment focuses on managing pain and function rather than modifying a disease — and why the best 'medicine' isn't a pill at all.
Neuropathic Pain: Why Painkillers Fail and Nerve Drugs Work
Some of the worst pain in medicine comes not from injured tissue but from injured nerves — the burning, shooting, electric pain of diabetes, shingles or nerve damage. And it plays by different rules: ordinary painkillers, even morphine, barely help. The drugs that DO work are borrowed from psychiatry and epilepsy, and understanding why is the key to treating this pain well.
Muscle Relaxants: Relieving Spasm and Spasticity
Muscles that are too tight cause real suffering — the painful spasm of a bad back, or the stiff, involuntary tightness (spasticity) of conditions like multiple sclerosis or a stroke. Muscle relaxants ease these, and the key is understanding two different problems and where each drug acts.
Migraine: Treating the Attack, and Preventing the Next One
Migraine is far more than a bad headache — it's a disabling neurological condition with its own specific drugs. The treatment splits cleanly into two jobs: stopping an attack that's happening now, and preventing attacks from coming. It's a fitting close to the pain section, and it brings back familiar drugs in yet another guise.
